Vomiting

Many different things can make kids throw up, including illnesses, motion sickness,
stress, and other problems. In most cases, though, vomiting in children is caused
by gastroenteritis, an infection of the
digestive tract.

Gastroenteritis, often called the "stomach flu," usually is caused by common
viruses that we come into contact with every
day. Besides causing vomiting, it also can cause nausea, belly pain, and diarrhea.

Gastroenteritis infections usually don't last long and are more disruptive than
dangerous. But kids (especially infants) who cannot take in enough fluids and also
have diarrhea could become dehydrated.
This means that their bodies lose nutrients and water, leading to further illness.

It's important to stay calm — vomiting is frightening to young children (and
parents) and exhausting for kids of all ages. Reassuring your child and preventing
dehydration are key for a quick recovery.

Giving kids the right fluids at the right time (called "oral rehydration") is the
best way to help prevent dehydration or treat mild fluid loss.

What Is Oral Rehydration?

When fluids are lost through vomiting or diarrhea, it's important to replace them
as soon as possible. The key is drinking small amounts of liquid often to replace
water and nutrients that have been lost.

The best liquids for this are oral rehydration solutions — often called oral
electrolyte solutions or oral electrolyte maintenance solutions.
They have the right balance of fluids and minerals to replace those lost to vomiting
and help kids stay hydrated.

Most electrolyte solutions are available at supermarkets or drugstores. If
you think your child is at risk for dehydration, call your doctor. He or she might
have specific oral rehydration instructions and can advise you on which solution
is best for your child.

Note: Over-the-counter medicines to treat nausea, vomiting, and diarrhea are not
recommended for babies and children. In some situations, doctors might recommend medicines
for nausea or vomiting, but these are available only by prescription.

Rehydration Tips: Babies (Birth to 12 Months)

Do not give plain water to an infant unless your doctor
tells you to and specifies an amount. Plain water by itself can disrupt the balance
of nutrients in your baby's blood.

If your baby is younger than 2 months old and vomits (not just spits up, but vomits
what seems like an entire feeding) at ALL feedings, call your doctor right away.

For Breastfed Babies

If your infant is exclusively breastfeeding
and vomits (not just spits up, but vomits what seems like the entire feeding) more
than once, breastfeed for shorter periods of time (about 5 to 10 minutes at a time)
every 2 hours. Increase the amount of time your baby feeds as he or she is able
to tolerate it.

If your baby is still vomiting on this schedule, call
your doctor. After about 8 hours without vomiting, you can go back to your normal
breastfeeding schedule.

For Formula-fed Babies

Offer small but frequent amounts — about 2 teaspoons (10 milliliters) —
of an unflavored oral electrolyte solution every 15–20 minutes with a spoon
or an oral syringe. Check with your doctor about which type of solution is best.

A baby over 6 months old may not like the taste of a plain oral electrolyte solution.
You can buy flavored solutions, or (only for babies over 6 months) you can add ½
teaspoon (about 3 milliliters) of juice to each feeding of unflavored oral electrolyte
solution.

If your baby can keep an electrolyte solution down for more than a couple of hours
without vomiting, slowly increase the amount you give. For instance, if your little
one normally drinks 4 ounces (about 120 milliliters) per feeding, slowly work up to
giving this amount of oral electrolyte solution as the day goes on.

Sometimes very thirsty babies will try to drink a lot of liquid quickly but can't
tolerate it. Do not give more solution than your baby would normally
drink in a sitting — this will overfill an already irritated tummy and
likely cause more vomiting.

After your baby goes for more than about 8 hours without vomiting, restart formula
slowly. Start with small, frequent feedings of half an ounce to 1 ounce, or about
20–30 milliliters. Slowly work up to the normal feeding routine. If your infant
already eats solids, it's OK to start solid feedings in small amounts again. If your
baby doesn't vomit for 24 hours, you can return to your normal feeding routine.

Rehydration Tips: Kids & Teens (Ages 1+)

Give clear liquids (avoid milk and milk products) in small amounts
every 15 minutes. The amount you give at one time can range from 2 teaspoons (10 milliliters)
to 2 tablespoons (30 milliliters or 1 ounce), depending on the age of your child and
how much your child can take without vomiting.

If your child vomits, start over with a smaller amount of fluid (2
teaspoons, or about 10 milliliters) and continue as above. Make sure to avoid straight
juices and sodas, both of which could make things worse. Kids may ask for commercial
sports drinks, but be careful with these — they have a lot of sugar and could
make things worse.

After no vomiting for about 8 hours, introduce solid foods slowly. But do not
force any foods. Your child will tell you when he or she is hungry. Your child might
want bland foods — saltine crackers, toast, mashed potatoes, mild soups —
to start out with.

If there's no vomiting for 24 hours, slowly return to your child's regular
diet. There's no need to leave out milk products unless they seem to be making vomiting
or diarrhea worse.

Vomiting due to gastroenteritis is caused by viruses that can spread to others.
So keep your child home from school or childcare until there's been no vomiting for
at least 24 hours. And remember that washing
hands well and often is the best way to protect your family against many infections.

When Should I Call the Doctor?

If your child refuses fluids or if the vomiting continues after you try the suggested
rehydration tips, call your doctor. Also, call for any of the signs
of dehydration below.

In babies:

few or no tears when crying

dry lips

fewer than four wet diapers per day in a baby (more than 4–6 hours
without a wet diaper in babies under 6 months of age)

fussy behavior

soft spot on an infant's head that looks flatter than usual or somewhat sunken

appears weak or limp

not waking up for feedings

In kids and teens:

no peeing for 6–8 hours

dry mouth (might look "sticky" inside), cracked lips

dry, wrinkled, or doughy skin (especially on the belly and upper arms and legs)

inactivity or decreased alertness

excessive sleepiness or disorientation

deep, rapid breathing

fast or weakened pulse

sunken eyes

Also contact your doctor if you notice any of the following, which could be a sign
of an illness more severe than gastroenteritis:

if your infant is under 2 months old and vomiting (not just spitting up)

projectile or forceful vomiting in an infant, particularly a baby who's younger
than 3 months old

vomiting after your baby has taken an oral electrolyte solution for close to 24
hours

vomiting that starts again as soon as you try to resume your child's normal diet